New Cancer Patients Retain Little Medical Information

WEDNESDAY Oct. 22, 2008 -- People hearing the devastating news that they have cancer have trouble remembering the details of the conversation with their doctor.

And, those who have the worst prognosis are likely to remember even less, a new study found.

Reporting in the Nov. 20 issue of the Journal of Clinical Oncology, researchers from the Netherlands and Australia found that most people just diagnosed with cancer remembered less than half of what their doctor had told them.

"In general, patients do not hear much of what is said after bad news is delivered. In this study, more than half of the provided information was forgotten," the researchers wrote.

"This is almost a universal problem, and doctors are trying to understand what patients take out of any medical encounter. Here, we have a life-threatening situation, and patients forget over half of what they're told," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

The new study included 260 people who were diagnosed with cancer and were seeing a medical or radiation oncologist for the first time. The average appointment lasted about 30 minutes, and each appointment was tape-recorded.

The researchers followed up with the study volunteers by telephone and asked them what they remembered from their appointments. They compared the answers to the tape recordings to assess how much information had been retained.

The researchers found that people under 65 recalled about 49.5 percent of what they'd been told, while those over 65 recalled about 48.4 percent of what the doctor had told them. Age made the biggest difference in recall when the amount of information presented was greater, and the consultation was longer.

Older people tended to ask fewer questions than younger ones, and surprisingly, those who asked the most questions had poorer recall. And people with a grimmer prognosis tended to remember less information than those with a brighter outlook, according to the study.

"Many conscientious physicians want to make sure that the patient has enough information, and what they might not realize is that it's almost a self-defeating process," said Lichtenfeld. He recommended that doctors offer their patients additional resources and support, such as the American Cancer Society's Web site or hotline. The U.S. National Cancer Institute offers a similar service.

Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La., said he always recommends that people bring family members or friends with them for their initial appointment with an oncologist, because it can be overwhelming for the patients. And, he said, at his center, "all patients leave with a copy of their pathology reports and information on the specifics of their treatment plan." Then, he said, patients come back in about three to five days, after they've had a chance to digest the information to talk with the doctor further.

Lichtenfeld also recommended bringing someone with you to your appointment, but said it wasn't always feasible for an oncologist to schedule two appointments, because there just aren't enough oncologists in some areas.

The study authors recommended that doctors use simple language, repeat important information and provide written or audio records for patients to review at their own pace.

A patient's ability to recall information isn't the only variable that might impede cancer treatment. Another potential problem is religious beliefs. According to a letter in the same issue of the journal, some Muslims undergoing cancer treatment feel they must fast -- forgoing food and sometimes liquid -- during Ramadan, which can have deleterious effects on their cancer treatment.

The letter points out that physicians should be aware that "Islam forbids fasting if this would be harmful to the individual," and this would be the case for someone undergoing cancer treatment. If necessary, the author recommends that a mosque imam might be helpful in convincing a patient not to fast during cancer treatment.